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Opioid toxicity in CKD — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentOpioid toxicity in CKDGPhC CRA

An 81-year-old man with eGFR 19 mL/min/1.73 m² has received modified-release morphine after surgery. He is difficult to rouse, has pinpoint pupils and a respiratory rate of 9 breaths/min. Oxygen saturation is 89% on air. Which is the most appropriate immediate pharmacy action?

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Correct answer: C — Trigger emergency assessment for opioid toxicity and respiratory support

Marked somnolence, miosis, hypoxaemia and bradypnoea constitute suspected opioid toxicity, not a routine dose-adjustment problem. Renal accumulation of morphine-6-glucuronide can make toxicity prolonged, so urgent airway and respiratory assessment, oxygen and titrated naloxone may be required with continued observation. Delaying review, substituting another morphine formulation or attempting an immediate patch conversion would not address the current respiratory emergency.

Reference: Morphgesic SR SmPC: https://www.medicines.org.uk/emc/product/4691/smpc